Correlation of Postoperative Results According to the Amount of Prostate Tissue Obtained in Patients Undergoing Transurethral Resection of the Prostate

TURGUT O1, ERBAGCI A1, BAYRAK O1, SECKINER I1, ERTURHAN S1, SEN H1

Research Type

Clinical

Abstract Category

Male Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 266
On Demand Male Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction
Scientific Open Discussion Session 22
On-Demand
Benign Prostatic Hyperplasia (BPH) Quality of Life (QoL) Bladder Outlet Obstruction Male Prospective Study
1. University of Gaziantep
Presenter
O

OMER TURGUT

Links

Abstract

Hypothesis / aims of study
Although many transurethral resection of the prostate (TUR-P) methods have been described, there is no consensus on how much tissue should be removed. It was aimed to evaluate the effect of the amount of tissue resected by TUR-P on lower urinary tract symptoms (LUTS) and postoperative parameters, in patients with benign prostatic obstruction (BPO).
Study design, materials and methods
Forty three patients who underwent TUR-P between 2018 to 2021 were evaluated prospectively. Groups were created according to the percentage of tissue taken from the patients. Group 1; those with less than 30% transurethral resection, and group 2; patients with more than 30% resection. Patients age, prostate volume, amount of resected tissue, operation time, hospital stay, catheter removal time, International Prostate Symptom Score (IPSS) before and 3 months after surgery, quality of life (QoL) score, maximal urine flow (Qmax), serum PSA  and hemoglobin (Hb) values were recorded. Patients with perioperative and postoperative complications were noted.
Results
The mean age of the patients was calculated as 68.6 years. Tissue taken from all patients was observed with an average of 36.2% with 27.7 g. In these patients, it was determined that the mean IPSS decreased from 29.4 to 5.3 (-81.9%, p=0.001); the average QoL reduced from 4.9 to 0.8 (- 83.7%, p=0.001); Qmax increased from 7.0 ml/sec to 17.4 ml / sec (+ 183.1%, p=0.001); PSA decreased from 7.5 to 2.5 ng/ml (-66.3%, p = 0.001). In group 1 and group 2, respectively; percentage of tissue taken: 22.2% vs 48.4% (p = 0.001); regression in IPSS: 77.7% vs 83.3% (p=0.048); improvement in QoL: 77.2% vs 84.8% (p=0.133); Qmax increase: 171.3% vs 193.5% (p=0.032); the decrease in serum PSA: 56.4% vs 69.2% (p=0.049). In addition, the duration of the operation: 38.5 vs 53.6 min (p=0.001), hospital stay 2.0 vs 2.4 days (p = 0.001), catheter time 4.1 vs 4.9 days (p=0.002), and decrease of Hb 10.7% vs 14.4% (p=0.001) was determined. Complications were observed in an equal number of patients in both groups. Hemoglobin decrease requiring transfusion in only one patient; urinary tract infection in four patients; urethral stenosis was noted in one patient (p = 0.778).
Interpretation of results
In Antunes et al.’s study, an average decrease of 16.7 units was observed in patients with <30% resection in IPSS, while a decrease of 18.4 units was observed in patients with> 50% resection. Again in this study, in QoL; 3.1 and 4.2 units of decrease were observed (1). In the present study, in IPSS; an average decrease of 21.2 (77.7%) in group 1, and 26.1 (83.3%) in group 2, in QoL; an average decrease of 3.55 (77.2%) in group 1, and 4.55 (84.8%) in group 2 was observed. With these results, it was noted that the change in IPSS and QoL was correlated with the resection rate (p <0.05). Pawha et al. showed that resection rate, and PSA decrease were correlated, and a 70% decrease in PSA could be possible with more than 60% resection (2). In the current study, a decrease of 56.4% in PSA with an average resection of 22.2% and a decrease of 69.2% in PSA was observed with a resection of 48.4% (p <0.05).
Concluding message
According to the results of the study, with resection performed at least 30%, there is a significant improvement in symptoms and parameters due to benign prostatic obstruction. However, in patients who are elderly, have comorbidities, and need to have a short operation time, less than 30% resection can effectively regress urinary symptoms and increase the quality of life.
Figure 1
Figure 2
References
  1. Antunes AA, Srougi M, Coelho RF, Leite KR, Freire GC. Transurethral Resection of the Prostate for the Treatment of Lower Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia: How Much Should Be Resected? International Braz J Urol. 2009;35:683-691.
  2. Pahwa M, Pahwa AR, Girotra M, Chawla A, Sharma A. Changes in S-PSA after transurethral resection of prostate and its correlation to postoperative outcome. Int Urol Nephrol. 2013;45:943-9.
Disclosures
Funding none Clinical Trial Yes Registration Number University of Gaziantep: Local Ethics Committee, Date: July, 3, 2019. Number: ve 2019/263 RCT No Subjects Human Ethics Committee University of Gaziantep: Local Ethics Committee, Date: July, 3, 2019. Number: ve 2019/263 Helsinki Yes Informed Consent Yes
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